HomeMy WebLinkAboutF2019-0162 - Permit Application�t Worksheet for Fire Permit Application o V"m
Print Form - �' 0Iq .01G2 City of Newport Beach - Building Division g
Please print 3copies
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Associated Building Permit # l �/� ` C` Fire Sprinkler F_ Fire Alarm Fire Misc
1. Project Address (Not mailing address) Floor Suite No
First
Tenant Name YVl G 0 # Units
2. Description of Work
_
Use
Extg Sq Ft New/Added Sq Ft F_, Total Sq Ft �'
Valuation $ lg�
State F6:;�r_-- Zip Telephone
# Stories
F_New F_Add (_ Alter F-, Demo
Last r First F
Check Appropriate Box for Applicant/Notification
F_ 3. Owner's Name Last i
First
Owner's Address
Owner's E-mail Address
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City /(%�f�O�7-
State F6:;�r_-- Zip Telephone
F_ 4. Architect/Designer's Name
Last r First F
Lic. No.
Architect/Designer's Address
ArchitecUDesigner's E-mail Address
City �
State � Zip [_ Telephoned
F- 5. Engineer's Name Last
� :First F_'
Lic. No. �—
Engineer's Address
Engineer's E-mail Address
City
StateZip �� Telephone
Lic. No. Ft74-e Class;, --.—
F 6. Contractor's Name Last' orYf-e 2 First6 el
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Contractor's Address
Contractor's E-mail Address
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1 G610 7o Ivey
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CitySSB
State Zip �Zo/ Telephone
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OFFICE USE ONLY-
� PERMIT NO.
E-:�t(-CZ—
TYPE OF CONSTRUCTION
PLAN CHECK
X
NO. `x^101
OCCUPANCY - GROUP
PLAN CHECK
FEE $